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An Anatomic Feasibility Study for Revascularization of the Ophthalmic Artery, Part I: Intracanalicular Segment.

Abstract

BACKGROUND

The anatomico-functional complexity of the ophthalmic segment aneurysms is attributable to the presence of critical neurovascular structures in the surgical field. Surgical clipping of the ophthalmic artery (OpA) aneurysms can result in postoperative visual deficit due to the complexity of the aneurysm, vasospasm, or optic nerve manipulation. In this study, we aimed to characterize the feasibility of an intracanalicular OpA (iOpA) revascularization with 2 donor vessels: an intracranial-intracranial (IC-IC) bypass using the anterior temporal artery (ATA) and an extracranial-intracranial (EC-IC) bypass using the superficial temporal artery (STA). We further discuss their potential role in "unclippable" OpA aneurysms.

METHODS

Twenty cadaveric specimens were used to evaluate the operative exposure of the intradural and intracanalicular OpA segments using an extradural-intradural intracanalicular approach. The arterial caliber and length at the anastomotic sites and required donor artery lengths were measured. The feasibility of the bypass using both donors was assessed.

RESULTS

The average length of the intradural and intracanalicular segment of the OpA was 9.5 ± 1.6 mm. The mean caliber of the iOpA was 1.5 ± 0.2 mm. The mean ATA length required for an ATA-OpA anastomosis was 26.7 ± 8.9 mm, with a mean caliber of 1.0 ± 0.1 mm. The mean length of STA required for the bypass was 89.9 ± 9.7 mm, with a mean caliber of 1.92 ± 0.4 mm.

CONCLUSIONS

This study confirms the feasibility of iOpA revascularization using IC-IC and EC-IC bypasses. These techniques could potentially be used for prophylactic or therapeutic neuroprotection from retinal ischemic injury while treating complex OpA aneurysms, infiltrative tumors, or intraoperative arterial injuries.

Authors+Show Affiliations

Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA. Electronic address: neurodriguez@gmail.com.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31541753

Citation

Rubio, Roberto Rodriguez, et al. "An Anatomic Feasibility Study for Revascularization of the Ophthalmic Artery, Part I: Intracanalicular Segment." World Neurosurgery, 2019.
Rubio RR, Gandhi S, Vigo V, et al. An Anatomic Feasibility Study for Revascularization of the Ophthalmic Artery, Part I: Intracanalicular Segment. World Neurosurg. 2019.
Rubio, R. R., Gandhi, S., Vigo, V., Tabani, H., Meybodi, A. T., Abla, A. A., ... Benet, A. (2019). An Anatomic Feasibility Study for Revascularization of the Ophthalmic Artery, Part I: Intracanalicular Segment. World Neurosurgery, doi:10.1016/j.wneu.2019.08.260.
Rubio RR, et al. An Anatomic Feasibility Study for Revascularization of the Ophthalmic Artery, Part I: Intracanalicular Segment. World Neurosurg. 2019 Sep 18; PubMed PMID: 31541753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Anatomic Feasibility Study for Revascularization of the Ophthalmic Artery, Part I: Intracanalicular Segment. AU - Rubio,Roberto Rodriguez, AU - Gandhi,Sirin, AU - Vigo,Vera, AU - Tabani,Halima, AU - Meybodi,Ali Tayebi, AU - Abla,Adib A, AU - Lawton,Michael T, AU - Benet,Arnau, Y1 - 2019/09/18/ PY - 2019/06/18/received PY - 2019/08/20/revised PY - 2019/08/22/accepted PY - 2019/9/22/pubmed PY - 2019/9/22/medline PY - 2019/9/22/entrez KW - Anterior clinoidectomy KW - Anterior temporal artery KW - Extracranial-intracranial bypass KW - Intracanalicular KW - Intracranial-intracranial bypass KW - Ophthalmic artery KW - Superficial temporal artery JF - World neurosurgery JO - World Neurosurg N2 - BACKGROUND: The anatomico-functional complexity of the ophthalmic segment aneurysms is attributable to the presence of critical neurovascular structures in the surgical field. Surgical clipping of the ophthalmic artery (OpA) aneurysms can result in postoperative visual deficit due to the complexity of the aneurysm, vasospasm, or optic nerve manipulation. In this study, we aimed to characterize the feasibility of an intracanalicular OpA (iOpA) revascularization with 2 donor vessels: an intracranial-intracranial (IC-IC) bypass using the anterior temporal artery (ATA) and an extracranial-intracranial (EC-IC) bypass using the superficial temporal artery (STA). We further discuss their potential role in "unclippable" OpA aneurysms. METHODS: Twenty cadaveric specimens were used to evaluate the operative exposure of the intradural and intracanalicular OpA segments using an extradural-intradural intracanalicular approach. The arterial caliber and length at the anastomotic sites and required donor artery lengths were measured. The feasibility of the bypass using both donors was assessed. RESULTS: The average length of the intradural and intracanalicular segment of the OpA was 9.5 ± 1.6 mm. The mean caliber of the iOpA was 1.5 ± 0.2 mm. The mean ATA length required for an ATA-OpA anastomosis was 26.7 ± 8.9 mm, with a mean caliber of 1.0 ± 0.1 mm. The mean length of STA required for the bypass was 89.9 ± 9.7 mm, with a mean caliber of 1.92 ± 0.4 mm. CONCLUSIONS: This study confirms the feasibility of iOpA revascularization using IC-IC and EC-IC bypasses. These techniques could potentially be used for prophylactic or therapeutic neuroprotection from retinal ischemic injury while treating complex OpA aneurysms, infiltrative tumors, or intraoperative arterial injuries. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31541753/An_Anatomical_Feasibility_Study_for_Revascularization_of_the_Ophthalmic_Artery._Part_I:_Intracanalicular_Segment L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)32428-3 DB - PRIME DP - Unbound Medicine ER -